Value-based health care providers emphasize prevention, wellness

It’s another nail in the fee-for-service coffin: A recent study from UnitedHealth Group finds that physicians who are paid a set monthly rate (global capitation) provided higher-quality care than those who are paid on a service-based system.

Calls for abandoning a FFS model and embracing payment reform have increased significantly since the start of the pandemic, as many independent primary care providers find themselves in financial distress due to the decrease in patient appointments. But such a system would not only provide financial stability for the provider but better outcomes for the patient, too.

Related: Fee-for-service is the crack cocaine of health care – with Brian Klepper

“Patients benefit because their doctors prioritize preventive care to keep them healthy and out of the hospital,” said Dr. Richard Migliori, chief medical officer at UnitedHealth Group. “Meanwhile, providers can offer valuable services that may not be paid for under fee-for-service. These findings underscore the importance of value-based care as a key element in building a better performing health care system for everyone.”

For its study, UnitedHealth used a series of metrics set by the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set (HEDIS) to compare outcomes for key chronic conditions in more than 5 million of its Medicare Advantage enrollees. The study found that patients treated by providers paid under a monthly rate:

• Were more likely to be screened for breast cancer and colorectal cancer
• Showed better control over blood sugar levels
• Were more likely to receive an eye exam
• Had higher rates of medication review

The study concluded that value-based physicians were in a better position to address preventive services and care management, as well as spend more time with patients. Using evidence-based clinical guidance and avoiding unnecessary interventions allowed them to focus on keeping patients out of the hospital.

Read more: 

• A secret weapon in our march toward value-based care
• Employers, physicians and insurers all moving away from fee-for-service model
• 3 aspects of value-based care every broker should know